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South Dakota rates for HCPCS 50075

Nephrolithotomy Rmvl Large Staghorn Calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,370.34 / $1,370.34 / $1,370.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,234.43 / $1,370.34 / $4,189.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,165.91 / $3,236.38 / $4,045.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,765.23 / $2,104.69 / $3,905.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,736.90 / $2,894.84 / $10,796.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,271.40 / $3,587.43 / $4,431.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,441.00 / $3,165.91 / $3,841.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,822.00 / $2,427.56 / $2,814.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,592.16 / $2,607.61 / $4,056.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,791.60 / $3,284.30 / $3,415.60